Drabble LA, Eliason MJ. Introduction to Special Issue: Impacts of the COVID-19 Pandemic on LGBTQ+ Health and Well-Being. J Homosex. 2021 Jan 13:1-15. doi: 10.1080/00918369.2020.1868182. Epub ahead of print. PMID: 33439789.
ABSTRACT
This special issue on the impacts of COVID-19 on LGBTQ+ health and well-being reports findings from nine articles with varied study designs, including data from multiple countries and all segments of LGBTQ+ communities. Key findings included the observation that pre-COVID mental health disparities predispose LGBTQ+ people to poorer outcomes; that technological communication aids are essential in maintaining some sense of community; and that substance use is perceived by sexual minority women as a means of coping with fears, stress, loneliness, and boredom. Studies in this special issue also document that community support is still a critical need, particularly among those who are sheltering at home with families of origin. Findings underscore the importance of addressing structural inequities, including advocating for rights; providing financial support for LGBTQ+ community organizations and networks; ensuring access to competent and affirming healthcare; and including vulnerable communities in disaster response and planning. Read more via Pubmed
Description of the special issue
This special issue of the Journal of Homosexuality focuses on the impact of COVID-19 on LGBTQ+ populations using empirical data and represents data collected from the U.S., Australia (including one set in Tasmania), Peru, Portugal, the UK, Italy, Brazil, Chile, Sweden, Belarus, Belgium, Egypt, France, Germany, Indonesia, Kazakhstan, Malaysia, Mexico, Russia, Taiwan, Turkey, and Ukraine. The study designs ranged from quantitative analysis of online surveys of non-probability samples and longitudinal cohorts to qualitative interviews, focus groups and participant observations. Some of the studies focus on subsets of the LGBTQ+ population such as gay, bisexual, and other men who have sex with men (Holloway et al., 2021), sexual minority women (Bochicchio et al., 2021; Cerezo et al., 2021), transgender and gender nonbinary populations (Garcia-Rabines & Bencich, 2021; Kidd et al., 2021) whereas others considered LGBTQ+ samples as a whole (Baumel et al., 2021; Gato et al., 2021; Grant, Gorman-Murray, & Walker, 2021; Moore, Wierenga, Prince, Gillani, & Mintz, 2021). The studies measured a variety of constructs such as mental health, substance abuse, social support, family acceptance, sexual satisfaction, beliefs and attitudes about COVID-19 and mitigation efforts, community support and acceptance, technology use, and a host of other important topics. Across these studies with diverse samples, locations, and research designs, findings corroborated the suspicions of LGBTQ+ health experts and organizations at the beginning of the pandemic that LGBTQ individuals are disproportionately impacted by COVID-19 and experience unique stressors related mitigation efforts Some of these key findings are described below.
While previous research, as well as many of the studies reported here, demonstrated that LGBTQ+ populations started out with disparities in mental health (depression and anxiety), the pandemic has exacerbated those disparities and likely widened the gap in mental health between LGBTQ+ and cis/heterosexual populations. Many respondents moved from slight to moderate elevations in mental health symptoms pre-pandemic, to clinically diagnosable disorders (Moore et al., 2021). Stay-at-home orders may be more stressful for LGBTQ+ individuals than for cisgender heterosexuals for many reasons, including the fact that many youth and young adults were forced to return to their families of origin, where they may not be out or where they are maltreated by family (Gato et al., 2021; Grant et al., 2021). Baumel et al. (2021) found that LGBQ study participants were more likely than heterosexuals to adhere to social distancing guidelines, which partly contributed to their greater psychological distress.
In addition, for many the COVID-19 lockdown meant losing access to LGBTQ+ public spaces, which were described as affirming of their identities and fostering a sense of belonging and connection (Grant et al., 2021). Navigating through public spaces was experienced as fraught, generating both feelings invisibility and concern about potential prejudice (Grant et al., 2021). Consistent with these studies, gay/bisexual and other men who have sex with men who reported staying in their homes or only going out for essentials reported more anxiety, loneliness, and sexual dissatisfaction than those who did not (or could not because of work) stay at home (Holloway et al., 2021).
In a few studies, respondents reported higher unemployment rates due to COVID-19 than in the general population. For example, the trans and nonbinary participants in Kidd et al. (2021) had an unemployment rate of 30% (13% pre-pandemic) compared to the 10% rate for the U.S. population in July of 2020. Moore et al. (2021) reported that the sexual and gender minority respondents were more likely to report job loss and financial difficulty than cis/heterosexual respondents.
In a unique case study, Garcia-Rabines and Bencich (2021) described how trans women living together in houses in Lima Peru banded together to survive the pandemic, and the supports that were and were not available to them. This study highlighted the importance of strong peer bonds and leadership within trans communities that are besieged by stigma. In addition, the study underscored the value of building partnerships with local nonprofit organizations to leverage access to tangible resources and the power of social cohesion in countering possible discrimination. For example, trans women went in pairs or in groups to the market to protect one another from discrimination. Furthermore, groups of women began to record and disseminate instances of discrimination, which ultimately reached mainstream media outlets, triggered public discussion of trans rights, and led to a change in police department policy.
Several studies found that the use of technology (i.e., texts, phone calls, video chats, social media or networking apps) was a way to stay connected with social networks and community among SGM individuals and increased during COVID-19 (Baumel et al., 2021; Cerezo et al., 2021; Grant et al., 2021; Holloway et al., 2021). One of these studies, which surveyed over 10,000 gay and bisexual and other men who have sex with men on an international networking app (Holloway et al., 2021), found that increased frequency of use of technology during the pandemic was associated with physical distancing. Another study (Baumel et al., 2021) found that use of computer mediated communication increased thriving across both LGBQ and heterosexual groups. Although LGBQ study participants reported greater use of these technologies, this did not attenuate disparities in psychological well-being. Given both the need to address disparities in psychological distress and familiarity with electronic tools, interventions that capitalize on technology may be promising for reaching LGBTQ+ individuals in crises such as the COVID-19 pandemic.
Two studies focused on substance use among sexual minority women, including some gender expansive individuals. Among 28 Californian college-aged participants (Cerezo et al., 2021), focus groups revealed that social media use led to online happy hours to offset stress and boredom and that the social norms promulgated on these sites normalized drinking as a coping strategy. Cerezo and colleagues pointed out that social media may be one of the largest influences on social norms about drinking for younger sexual minority women, and the greater reliance on social media during the pandemic is accelerating drinking in this population through online happy hours and quarantine drinking games. Among older sexual minority women who were part of a longitudinal study in Chicago (mean age of 53.5; Bochicchio et al., 2021), the 16 women who were interviewed reported that they had created new drinking routines, such as day time drinking or drinking on workdays, but also became more aware of and started to monitor their alcohol use as the pandemic wore on. They also pointed to the role of drinking to relieve both stress and boredom from loss of work and social routines.
The study by Kidd et al. (2021) is unique in focus and design, drawing 208 transgender and gender nonbinary individuals from a longitudinal cohort study in three geographically dispersed cities in the U.S. One-third of the sample had experienced an interruption or delay in receiving gender-affirming hormones and 11% had a surgery canceled or postponed. This group also suffered from a perceived reduction in LGBTQ+ community support, which in turn increased their levels of psychological distress. The double stress of reduced community support and limited access to of gender-affirming care may exacerbate health disparities.